Provider Demographics
NPI:1528408705
Name:MIDWEST PRACTICE SOLUTIONS STL LLC
Entity Type:Organization
Organization Name:MIDWEST PRACTICE SOLUTIONS STL LLC
Other - Org Name:MOBILE MEDICAL DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-308-4155
Mailing Address - Street 1:14585 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3963
Mailing Address - Country:US
Mailing Address - Phone:888-308-4155
Mailing Address - Fax:314-965-8705
Practice Address - Street 1:14585 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-3963
Practice Address - Country:US
Practice Address - Phone:888-308-4155
Practice Address - Fax:314-965-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4722Medicare PIN